• 대한후두음성언어의학회지
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• 제8권2호
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• pp.225-231
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• 1997

The persistent and recurrent dysphonia after microlaryngeal surgery was noted in tweleve patients. We reviewed the results of laryngostroboscopy, psychoacoustic evaluation, aerodynamic study and acoustic analysis according to the treatment modality. The causes of persistent dysphonia were attributed to vocal cord scarring, recurrent mass lesion, residual mass lesion, persistent inflammation, and hyperfunctional voice disorder. We noticed the better vocal function in the group treated with voice therapy or surgical therapy than the group treated with voice rest and medication. Therefore, we concluded that vocal function can be improved with the use of active, multidisciplinary approach which includes voice therapy, medical treatment and selected surgical resection according to the laryngeal lesions.

• Clinical Endoscopy
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• 제55권5호
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• pp.655-664
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• 2022

Background/Aims: Endoscopic submucosal dissection (ESD) for residual or recurrent colorectal lesions after incomplete resection is challenging because of severe fibrosis. This study aimed to compare the efficacy of the pocket-creation method (PCM) with a traction device (TD) with that of conventional ESD for residual or recurrent colorectal lesions. Methods: We retrospectively studied 72 patients with residual or recurrent colorectal lesions resected using ESD. Overall, 31 and 41 lesions were resected using PCM with TD and conventional ESD methods, respectively. We compared patient background and treatment outcomes between the PCM with TD and conventional ESD groups, respectively. The primary endpoints were en bloc resection and R0 resection rates. The secondary endpoints were the dissection speed and incidence of adverse events. Results: En bloc resection was feasible in all cases with PCM with TD, but failed in 22% of cases of conventional ESD. The R0 resection rates for PCM with TD and conventional ESD were 97% and 66%, respectively. Dissection was significantly faster in the PCM with TD group (13.0 vs. 7.9 mm²/min). Perforation and postoperative bleeding were observed in one patient in each group. Conclusions: PCM with TD is an effective method for treating residual or recurrent colorectal lesions after incomplete resection.

• Archives of Plastic Surgery
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• 제33권5호
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• pp.666-668
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• 2006

Purpose: Livedo vasculitis is recurrent painful ulceration of the feet, ankles and legs characterized by purpuric papules and plaques that undergo superficial necrosis and healing with residual white atrophic scars (atrophie blanche). The typical histopathologic findings of livedo vasculitis are characterized by endothelial proliferation and hyaline degeneration along with thrombosis of dermal vessels. Standard therapeutic strategies for treatment of livedo vasculitis are usually on the basis of rheologic, anti-inflammatory or immnosuppressive treatments, a aspirin, dipyridamole, glucocorticosteroids, pentoxyfylline, or high-dose intravenous immunoglobulin are often ineffective or partially effective. Methods: We report a case of 24-year-old male patient with livedo vasculitis on the ankles and dorsal surfaces of both feet. Results: The lesion that had been unresponsive to medical treatment were successfully healed with complete debridement and skin grafting without recurrences. Conclusion: Surgical treatment can be one of the therapeutic choice in Livedo vasculitis.

• Journal of Chest Surgery
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• 제18권1호
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• pp.97-103
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• 1985

During the period of seven years from Jan. 1976 to Jan. 1983, one hundred cases of pulmonary tuberculous residual lesions were resected at the Department of Thoracic Surgery, Paik Hospital in Seoul, Korea. During the period of this study, 1764 patients were admitted with the diagnosis of pulmonary and/or pleural tuberculosis in the medical and surgical department as a primary or associated conditions. Among these 1764 patients, one hundred selective cases were operated. The results were as follows; l. Extents of the disease by the predominant clinical pictures were: totally destroyed lung; 18, destroyed lobe; 6, cavitary lesion with or without positive sputum; 35, bronchiectasis; 7, bronchostenosis with atelectasis; 2, empyema with or without BPF; 20, pleural thickening; 4, tuberculoma; 3, bullous cyst with tuberculosis; 5 cases, or per cent [Table 1]. 2. Male and female ratio was 1.2:1 or 55 and 45 per cent. Age distribution ranged 15 and 55 with average of 33 years [Table 2]. 3. Type of procedures were: pleuropneumonectomy; 15, pneumonectomy; 25, lobectomy; 37, bilobectomy; 6, lobectomy plus segmentectomy; 3, pleurectomy; 14 cases, or percent, Site of resections were: right; 58 and left; 42 cases, or per cent [Table 3]. 4. Incidence of complications were 10 per cent and the mortality was 4 per cent. The causes of morbidity were analyzed. The main causes of death were pulmonary insufficiency; 2, cardiac arrhythmia; 1, and hepatic insufficiency; 1 case or per cent [Table 4]. 5. Pathologic examinations of the resected pulmonary and pleuropulmonary lesions were observed by gross specimen, correlating with the pre-operative indications of the disease [Fig. 1, 2, 3, 4, 5, 6].>br> 6. Anti-tuberculous chemotherapy was done for 6 to 18 months, post-operatively, in 80 patients. Of these 49 cases were need medication for 12 months [Table 5]. Except the four operative mortality and a case of post-operative recurrent buberculosis under medication, all the other 95 cases are well in activity and free from the disease at the moment.

• Journal of Korean Neurosurgical Society
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• 제30권sup2호
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• pp.289-293
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• 2001

Objectives : The optimal treatment of craniopharyngioma is controversial. Despite recent advances in microsurgical management, complete surgical removal of craniopharyngioma remains very difficult. Radiation added to surgery is effective, but radiation therapy resulted in untoward side effect in young patient. Gamma knife radiosurgery offers the theoretical advantage of a reduced radiation dose to surrounding structures during the treatment of residual or recurrent craniopharyngioma compared with fractionated radiotheraphy. We described retrospective analysis of tumor size and clinical symptoms of patients after gamma knife radiosurgery in residual or recurrent craniopharyngioma were performed. Material and Methods : From September 1990 to January 2000, 18 patients of craniopharyngioma were treated by gamma knife radiosurgery. All patient had undergone surgery, but residual or recurrent tumor was found and all of them treated postoperative gamma knife radiosurgery. The mean age was 19(from 6 to 66) and male to female ratio was 10 to 8 and 8 patients were below 15 years old. In young age group(below age 15), the average volume of the tumor was $2904.8mm^3$ and mean maximal gamma knife dose was 34.9Gy. In old age group(older than 15), the average volume of the tumor was $2590.4mm^3$ and mean maximal gamma knife dose was 45.2Gy. The size of the tumor was average $2730.1mm^3$($88-12000mm^3$), mean average radiation dose was 40.7Gy and the mean prescription dose was 17.6 Gy(4-35Gy) delivered to a median prescription 50.7% isodose. Results : The follow up was from 1 year to 9 years(mean 59.1 months) after gamma knife radiosurgery. The tumor was controlled in 13(72.2%) patients. The tumor decreased in 9 patients and not changed in 4 patients. The tumor size increased in 4(22.2%) patients during follow up period. In two cases the tumor size increased because of its cystic portion was increased, but their solid portion of the tumor was not changed. In another two patients, the solid portion of the tumor was increased. So, one patient underwent reoperation and the other patient underwent operation and repeated gamma knife radiosurgery. The tumor recurred in one case(5.6%) that is a outside of irradiated site. The presenting symptoms were improved in 4 patients(improved visual acuity in 1, controlled increased intracranial presure sign in 3 patients). In one case, visual acuity decreased after gamma knife radiosurgery. The endocrine symptoms were not influenced by gamma knife radiosurgery. Conclusion : Craniopharyngioma can be treated successfully by gamma knife radiosurgery. Causes of the tumor regrowth are inadequate dose planning because of postoperatively poor margination of the tumor, close approximation of optic nerve and residual tumors outside the target lesion. Recurrence can develop 4 years after gamma knife radiosurgery. Volume is important, but the accurate targeting is more important to prevent tumor recurrence. If the tumor definition is not clear during planning gamma knife surgery, long-term image follow up is required.

• Radiation Oncology Journal
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• 제6권1호
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• pp.63-73
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• 1988

One hundred fifty-four patients with the carcinoma of the uterine cervix were studied retrospectively to assess the result and impact of treatment at Department of Radiation Oncology, Korea University, Hae-Wha Hospital from Feb 1981 through Dec. 1986. Prior to radiotherapy, the patients were evaluated and staged by recommendation of FIGO including physical examination, pelvic examination, cystoscopy, rectosigmoidoscopy, chest X-ray, IVP. Ba enema. Also, an additional pelvic CT scan was obtained for some of the patients. The patients were treated by radiotherapy alone or adjuvant postoperative irradiation; in case of radiation therapy only, whole pelvic irradiation was given with Co-60 teletherapy unit via AP and PA parallel opposing fields or 4-oblique fields, 180 cGy per day, 5 days per week and intracavitary insertion was performed. In satges Ia, Ib, and IIa with small primary lesion, external irradiation was initially given to pelvis up to $2,000\~3,000\;cGy/2frac{1}{2}\;-3frac{1}{2}$ weeks and then intracavitary insertion was performed using Fletcher-Mini-Declos Applicator with cesium-137 cources and followed by external irradiation of $1,000\~2,000\;cGy/1frac{1}{2}\;-2frac{1}{2}$weeks via AP and PA parallel opposing fields with midline shield to spare of bladder and rectum. However, if the primary lesion is large, external irradiation was given without midline shield. More than stages IIb, the patients were treated by external beam irradiation up to 5,400cGy/30f for 6 weeks via 4-oblique portals and at the dose of 5,040cGy/28f the field was cut 5cm from the top margin for spare of small bowel, and followed by intracavitary irradiation, If there was residual tumor an additional dose of $900\~l,200cGy/5\~7f$ was given to parametrium and/or residual tumor area. Total dose of radiation to A and B-point were as follows; A-point; In early stages, Ia, Ib, IIa; $8,000\~9,000$ B-point $5,000\~6,000 cGy$ A-point; In advanced stages IIb, IIIa, IIIb; $9,000\~10,000$ B-point $60,000\~7,000cGy$ The results were obtained and as fellows; 1 The patients distribution according to FIGO staging system were stage Ia 6, Ib 27, IIa 28, IIb 54, IIIa 12, IIIb 18, and stage IVa 9. 2. Value of CT scan were demonstration of cervix tumor mass, parametrial and pelvic side wall tumor spread, pelvic and inguinal lymph nodes metastases, and hydronephrosis. Three dimensional quantitative demonstration of tumor volume is also important in planning radiation therapy. Another advantage of CT scan was detection of recurrent tumor after radiation or surgery. 3. Local control rate of tumor according to the size was $91.3\%$ for less than 5cm in size and $44.6\%$ in tumor over 5cm (p<0.0068). 4. Thirty out of 50 recurrent sites has locoregional failures and 17 cases has distant metastases. And the para-aortic lymph nodes were the most common site for distant metastases. 5. The most common complication was temporal rectal bleeding which was controlled most by conservative management. However, 4 patients required for endoscopic cauterization. 6. The 5-year survival rates showed; stage la and Ib $95\%,\;stage\;IIa\;81\%\;stage\;lIb\;67\%,\;stage\;IIIa\;37.7\%,\;stage\;IIIb\;23\%$ and 3-year survival rate of stage IVa showed $11.6%$, retrospectively.

• 대한두경부종양학회지
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• 제17권2호
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• pp.205-209
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• 2001

Purpose: Most cases of primary hyperparathyroidism are due to parathyroid adenoma or parathyroid hyperplasia. Parathyroid carcinoma is a very rare cause of hyperparathyroidism. Although the diagnosis of parathyroid carcinoma is usually established by pathologic criteria especially of vascular or capsular invasion, some clinical and biochemical features differentiate it from benign forms of hyperparathyroidism. We under-took a retrospective study in 6 patients with parathyroid carcinoma, with the aim of conveying experience from management for this rare cause of hyperparathyroidism. Methods: Clinical symptoms, biochemical laboratory, radiologic, and intraoperative findings, local recurrence and distant metastasis were analyzed in 6 patients diagnosed pathologically as a parathyroid carcinoma after operation from 1992 to 2001. Results: Mean age was 50.2 years (33.0-60.0 years) and male to female ratio was 1:1. Neck mass was found in 5 patients, multiple bone pain in 3 patients and renal stone in 1 patient. One case has suffered from chronic renal failure for 19 years. Although preoperative laboratory evaluations showed the aspects of hyperparathyroidism in all cases, mean serum calcium level was 11.2mg/dl(10.5-12.1mg/dl), slightly elevated. Laboratory values after surgery were within the normal range in 5 cases. However, in one case with chronic renal failure, serum PTH levels, serially checked, were above the normal range. Any of imaging methods failed to suggest a parathyroid carcinoma preoperatively. Parathyroid adenoma was suspected in 3 cases, thyroid cancer in the other cases before surgery. The extent of resection was radical resection of parathyroid lesion with more than unilateral thyroid lobectomy and central compartment neck node dissection and in 2 cases, the resection of recurrent laryngeal nerve or strap muscles was added. During follow-up period, any local or systemic recurrence were not evident in all the cases. Conclusion: Although parathyroid carcinoma is a rare disease and its preoperative diagnosis, in our experience, could not easily be made, the understanding of characteristic clinical and biochemical feature could help diagnosis at first surgery. Radical resection without remaining residual tumor is most important for the management of the parathyroid cancer.

• 대한핵의학회지
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• 제31권3호
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• pp.356-364
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• 1997

분화된 갑상선암의 수술후 경과 관찰에서 암조직의 잔류, 전이, 혹은 재발로 생각하여 치료적 용량의 방사성 옥소를 투여한 30명의 환자를 대상으로 I-131 진단적 스캔과(5mCi 이하), Tc-99m MIBI 스캔, 갑상선호르몬 투여중의 티로글로블린(Tg(on)), 갑상선 호르몬 투여중단 후의 티로글로블린(Tg(off))및 I-131 치료적 용량 스캔을 시행하여 다음의 결과를 얻었다. 1) I-131 진단적 스캔의 양성율이 Tc-99m MIBI 스캔보다 13% 더 논게 나왔다. 2) Tg(on) 혹은 Tc-99m MIBI 스캔의 양성율에 비해 Tg(off) 혹은 I-131 진단적 스캔의 양성율이 Tg(off)의 양성 기준치와 상관없이 Tg(on)이 1.5ng/ml, 5ng/ml시 각각 14%, 18% 더 높았다. 3) Tg(on)의 예민도는 1.5ng/ml, 5ng/ml을 양성기준치로 할 경우 각각 68%, 50%로 나와 양성 기준치를 1.5ng/ml로 할 경우 더 높은 예민도를 보였으며 Tg(off)의 예민도는 양성 기준치를 10ng/m1, 40ng/ml로 할 경우 각각 77%, 59%를 보였다. 4) Tc-99m MIBI 스캔에 양성이면서 I-131 진단적 스캔에 위음성을 보였던 경우도 4예에 해당하였다. 결론적으로, Tc-99m MIBI 스캔은 갑상선 호르몬을 중단하지 않은채 Tg(on)과 함께 측정한다면 갑상선암의 재발을 스크리닝 하면서, Tg(off) 및 I-131 진단적 스캔을 보완할 수 있는 유용한 검사로 생각된다.

• 대한족부족관절학회지
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• 제26권1호
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• pp.22-29
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• 2022

Purpose: Despite continuous updates of standard treatment guidelines for acute ankle sprain and chronic ankle instability (CAI), in practice preferred treatment protocols vary widely. Based on a Korean Foot and Ankle Society (KFAS) member survey, this study reports current trends in the management of ankle ligament injuries. Materials and Methods: A web-based questionnaire containing 34 questions was sent to all KFAS members in September 2021. Questions mainly addressed clinical experience and preferences for the diagnosis and treatment of ankle ligament injuries. Answers with a prevalence of ≥50% among respondents were considered to reflect tendencies. Results: Eighty-four of the 550 members (15.3%) responded. Answers that showed a tendency were as follows: commonest additional image study (ultrasound), conservative treatment modality (immobilization, oral medication), frequency of surgical treatment (<5 cases per annum), most important factor when deciding on surgical treatment (activity level, e.g., occupation or sport), and commonest surgical procedure (open ligament repair). Answers that showed a tendency for CAI were as follows: most important symptom (repeated sprain, giving way), radiological factors (talar tilt, osteochondral lesion, anterior talar translation), and patient factors (occupation, sports activities, recurrent instability after surgery, etc.). For decision making regarding surgical treatment and method, the most preferred surgical procedure was the modified Broström procedure, and the most common repair technique was suture anchor technique. The following were considered poor prognostic factors; generalized laxity, failed previous surgery, cavovarus, severe mechanical instability, heavy work, obesity, and dissatisfaction after surgery because of residual pain. Conclusion: This study updates information regarding current trends in the management of ankle ligament injuries in Korea, and reveals consensus opinions and variations in approaches to patients with an acute or chronic injury. The divergence of approaches identified indicates the need for further studies to determine standard guidelines and long-term results.

• Radiation Oncology Journal
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• 제11권2호
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• pp.241-247
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• 1993

가톨릭 의과대학 강남성모병원 치료방사선과에서는 1988년 7월부터 1992년 12월 사이에 뇌종양 환자 45명의 뇌내 46개 병소에 대한 뇌정위다방향방사선치료를 실시하였으며, 이들에 대한 영상학적 및 임상적 추적조사 결과를 후향적으로 분석하였다. 뇌종양에 대한 뇌정위다방향방사선치료는 병소가 생명중추에 인접되어 있거나 다른 전신질환과 함께 있어 종양의 수술적 제거가 어려운 경우, 수술후 잔류 병소가 남아 있거나 재발된 경우, 또는 종래 부터 해오던 방사선치료에도 불구하고 잔류병소가 남아있거나 환자가 수술을 거부할 경우 등에서 실시하게 된다. 이는 수술이나 유사한 다른 치료와 비교하여 동일한 치료효과를 얻으면서도 간편하고 비침습적 이며 또한 상대적으로 저렴한 치료 경비가 소요됨으로, 최근 방사선치료장비 및 치료계획 프로그램의 개발과 함께 그 치료성적이 관심의 대상이 되고 있다. 환자 분포는 남녀 비가 22:33 이며, 연령 분포는 5-74세 (중앙값 : 43세)이었고, 추적조사 기간은 2-55개월 (중앙값 : 35개월)이었다. 6 MV 선형 가속기를 사용하여 조사야 용적은 $0.13-42.88\;cm^3$(중앙값 : $7.26\;cm^3)$이었으며, 최대치료선량은 5-35.5 Gy(중앙값 : 20.9 Gy)이었다. 종양 별로는 뇌하수체종양15예, 청각신경종 8예, 수막종 7예, 뇌교종 6예, 두개인두종 4예, 송과선종 3예, 혈관아세포종 2예, 및 뇌전이 암 1예 씩이었다. 총 46예 중 18예$(39.1\%)$에서 추적 영상검사상 종양의 소실 및 위축을 관찰하였으며, 10예$(34.8\%)$에서는 종양크기의 정지상태를 나타냈다. 임상적으로는 34예$(73.9\%)$에서 방사선치료 전보다 양호한 전신상태 및 수행능력을 유지하고 있었으며, 이중 4예 $(8.7\%)$에서는 추적 검사상 종양 크기가 약간 커졌음에도 불구하고 임상적으로는 안정된 상태이었다. 영상학적으로나 임상적으로 악화된 경우는 2예$(4.4\%)$에서 있었다. 치료에 따르는 부작용으로는 치료 직후, 일시적 두통을 호소하였으나 스테로이드 및 진통제 투여로 개선되었으며 경미한 일시적 탈모를 3예$(6.6\%)$에서 경험하였으며 향후 좀더 정밀 추적검사가 필요할 것으로 생각된다.